Provider Demographics
| NPI: | 1386079200 |
|---|---|
| Name: | CAPABLE KIDS LLC |
| Entity type: | Organization |
| Organization Name: | CAPABLE KIDS LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | CRAIG |
| Authorized Official - Middle Name: | DOUGLAS |
| Authorized Official - Last Name: | STOVER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 724-301-3772 |
| Mailing Address - Street 1: | 135 SNYDER RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HERMITAGE |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 16148-3431 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 135 SNYDER RD |
| Practice Address - Street 2: | |
| Practice Address - City: | HERMITAGE |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 16148-3431 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 724-342-3898 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2013-09-10 |
| Last Update Date: | 2017-02-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 1028641660001 | Medicaid |
